To Fix Health Care, Leaders Need to Let Go of the Status Quo

In health care, the Hippocratic Oath — “first, do no harm” — can hold as much sway in the board room as it does in the exam room. Among health care leadership, it can have the unintended effect of promoting inaction over change and innovation. As a result, U.S. health care has become akin to a smothered child—stifled and arrested. If we actually gave it some room to breathe, if we metaphorically opened the doors to let it run around outside, take chances, and fall down occasionally, it could grow into something different, surprising and more satisfying than anything we could have imagined. It’s time, in my view, to let our little precious grow up.

So what can health care leaders do to help U.S. health care flourish in the 21st century? As a first step, I believe that administrators of the large tertiary hospitals that currently sit atop the U.S. health care food chain need to loosen their grip on the industry by focusing on what they do best. They should jettison the commodity business that other players can do just as well or better, all the tests and procedures (from throat swabs to colonoscopies) that should be done in more convenient and less expensive care settings, whether that be neighborhood clinics, at a Walgreens or Target, or even through telemedicine. There’s no need for highly-specialized, hospital-based care teams, for example, to waste their time on what is often considered basic community treatment—for which hospitals charge twice or three times as much.

Giving up any form of revenue or market share at a large health system these days would be a courageous decision, but these health systems can make up the revenue (and more) by focusing on performing highly complex, specialized procedures—which often have the biggest of all profit margins—and building a national market for those procedures. Some are already successfully applying this strategy. The Cleveland Clinic, for example, struck a deal with Loews to have their employees across the nation fly in if they require cardiac surgery. By expanding the market they serve, Cleveland Clinic is doing the services they can do best for a much broader population of patients. They’re growing their addressable market, but narrowing the scope of what they deliver. This is a trend in health care that can and should take a hold – even if it might mean creative solutions such as paying for patients and their families to travel to your hospital (by private jet, in some cases). As hospitals do more of these expensive and complicated procedures, they’ll figure out how to streamline the process and make it even more profitable.

Health care leaders can also help the industry flourish by realizing the benefits of giving more power, where appropriate, to non-physicians. Many years ago, during a brief stint as an army medic, I learned firsthand how effective the army is at teaching sophisticated procedures to enrollees, no matter their educational background. Within weeks, I could see that some were operating multi-million-dollar Stinger missile systems – some of the most sophisticated combat equipment ever devised. They could do it because the instructions were broken down into steps that just about anyone could learn. Evidence suggests the same principal can and should be applied in health care.

More generally, health care leaders should also open their doors more to outsiders—especially those people the famous Apple commercial dubbed the “crazy ones.” Entrepreneurs’ solutions are often basic and unflashy and some of them are born in makeshift offices in dingy basements. But at their best they feed off inefficiencies and make the whole system healthier as a result. Consider Beyond Lucid, a startup that provides communications for emergency response teams. Currently, ambulance crews have no means of providing advance information about emergency patients to hospitals—the primary tools today are a Sharpie pen on three-inch tape and a walkie-talkie. With a status quo like that, a basic and secure communications link can bring dramatic improvement. For the large, established med-tech companies with whom most health care leaders have relationships, that’s probably too small a market to target. But for an entrepreneurial company such as Beyond Lucid, it’s delicious, low-hanging fruit. It’s time to start taking their call.

Finally, health care leaders need to encourage a market for data so that information can flow and be easily exchanged—the lifeblood of any renaissance. And here we need the government to help out. The government has done good work protecting people’s rights to data, promoting electronic health records, and defending privacy. But it has inadvertently prevented the emergence of a functioning market for data in which parties are free to reimburse each other for information — think of landing in Paris or Singapore and accessing a U.S. bank account for a nominal fee through an ATM. In health care, the government currently forbids such payments under misaligned anti-kickback laws — something my company, athenahealth, has lobbied hard to have repealed. A data market would create incentives for caregivers at every level to invest in data management and provide prompt data-related services to patients and to other caregivers.

Access to data and information will improve health care by facilitating deductive problem solving—the mother of innovation. New ideas will emerge and will be irresistible to an often recalcitrant industry because they will be based on observable patterns. Data will help medical practices and hospitals run their businesses efficiently by showing them (often for the first time) what they’re doing – where they’re winning and where they’re losing, whether they’re delegating effectively or not, when orders are going out of network and why. This process sounds simple, but it will bring astounding efficiency gains. Data will also help with diagnoses and treatment, and with the management of patient populations, whether it’s diabetics, men of a certain age group, or children with rare diseases. Data will back up doctors’ informed gut intuitions, which are invaluable, with population-level statistics. This will lead to incredible qualitative gains. Eventually, data-sharing will allow the entire health care system to become a living laboratory for tracking and improving outcomes and interventions. Health care will become a more efficient learning system—capable of continuous and real-time improvement.

We are standing on the edge of a great opportunity. The current wave of health care reform, whether effective or not, has set things in motion for change. If health care leaders can let go of the status quo the result will be a pluralistic, diverse and flourishing health care ecosystem—an American success story. Doing this requires a gamble, however: the belief that American ingenuity will prevail even in times of upheaval. How can you not like those odds?